This application is in response to Notice Number NOT-OD-10-033, titled "NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications for HIV/AIDS-related Research through the NIH Basic Behavioral and Social Science Opportunity Network (OppNet). This revision application proposes to add aims to an existing R01 project measuring the effectiveness of patient-navigator enhanced case management in improving the health outcomes of HIV-infected jail inmates transitioning back into the community. In this revision, we will conduct ethnographic research to explore how patient navigators and their clients work together to define and engage in activities that operate to reduce HIV risk and improve access to care for this high needs population. Although there is evidence linking patient navigation to improved health outcomes, little is known about the mechanisms by which the model works to impact these changes. In our parent project, we are conducting a randomized controlled trial to investigate the effectiveness of patient navigation in improving health outcomes for HIV-infected clients leaving jail. The parent project uses quantitative measures from medical records and clients assessments. With these measures we will be able to assess how much and what types of services are associated with health care access and outcomes. This design, however, does not allow us to understand the mechanisms by which the patient navigators themselves are able to affect the quality and quantity of service. With our current design, neither can we understand how the relationships and communication patterns that occur between clients and patient navigators influence health. With our current design, we are unable to generate basic behavioral hypotheses about how patient navigation operates to affect outcomes. The data collection strategies proposed in this revision application will allow us to expand our inquiry so that we are able to fully describe and understand the dynamics of the patient navigator model. The scope and budget of the original proposal did not allow us to propose an in-depth inquiry using ethnographic methods. The opportunity provided by OppNet allows us to add fundamentally different b-BSSR aims not proposed in the original application. The specific aims of this proposed revision are to: 1) explore how patient navigators and their clients work together to define and engage in activities that may reduce HIV risk and improve access to care;2) explore how characteristics of the social service environment constrain or enable health care seeking behavior for clients and patient navigators working on their behalf, and;3) generate a theoretical model describing patient navigator, client and health care system factors and the mechanisms by which they interact to influence health care access and client risk taking behavior. Our study will identify and explore factors at the heart of the model, which requires interaction between patient navigators, their clients and the service environment in which they work together to create change. This will contribute to the body of knowledge on patient navigation by generating knowledge about the basic behavioral mechanisms at work and the factors in the health care environment that constrain or engage them. Preliminary theory development will provide testable hypotheses for future research. PUBLIC HEALTH RELEVANCE: This revision application proposes to add aims to an existing R01 project measuring the effectiveness of patient-navigator enhanced case management in improving the health outcomes of HIV-infected jail inmates transitioning back into the community. In this revision, we will conduct ethnographic research to explore how patient navigators and their clients work together to define and engage in activities that operate to reduce HIV risk and improve access to care for this high needs population. In our parent project, we are conducting a randomized controlled trial to investigate the effectiveness of patient navigation in improving health outcomes for HIV-infected clients leaving jail. The parent project uses quantitative measures from medical records and clients assessments. With these measures we will be able to assess how much and what types of services are associated with health care access and outcomes. This design, however, does not allow us to understand the mechanisms by which the patient navigators themselves are able to affect the quality and quantity of service. With our current design, neither can we understand how the relationships and communication patterns that occur between clients and patient navigators influence health. With our current design, we are unable to generate basic behavioral hypotheses about how patient navigation operates to affect outcomes. The data collection strategies proposed in this revision application will allow us to expand our inquiry so that we are able to fully describe and understand the dynamics of the patient navigator model.